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Thursday, November 19, 2015

My Dr. Visits

These are my visits to 3 separate offices in 3 different cities over the last couple months. And people complain about their pharmacies...

Office opens at 8am.
My appt. time is 8:50 (please arrive 15 minutes early-checked in at 8:35)
Office specialist calls me up at 8:45 to get my ID, insurance, and signature to allow treatment.
Nurse takes me back at 8:55.
Nurse leaves office at 9:17 and says doctor will be right with you.
Doctor walks in at 9:48 and we chat. He leaves at 9:57.
Checkout lady takes me around to schedule follow up testing and I leave the office at 10:24.

Second Office scenario: Appt. time is 8:30 (please arrive at 8am for paperwork, ID, background check, whatever). No one else in the waiting room.
Nurse takes me back at 8:31, checks vitals, says doctor will be in "as soon as he arrives" and offers me coffee.
Doctor arrives at 9:21 and we chat. He shows me to the front desk (9:30) where I wait for my prescriptions, a review of our discussion, and further instructions from the nurse. Leave office at 9:36.

Third Office visited: Packed waiting room for appt. time of 10:30 (arrive early as is customary).
Taken back to room at 10:32. Hear doctors talking about their Fantasy Football Results/Upcoming Games. Doctor enters the room at 11:21. We leave office at 11:29. He shows me to checkout and leaves. I have blood drawn and receive prescription orders. Walk out of office at 11:39.

Whatever. The obvious point is this: They have all these different stations and my entire 9 minute appointment actually took 109 minutes (8:35 to 10:24), then 96 minutes, then 75 minutes. For what? No one in the waiting area complained. No one huffed. No one threatened to go across the street. Everyone could see other people waiting. Everyone just accepted they were busy. How is this acceptable?
Is it because most of the wait time was spent in the actual room, closed off from the rest of society?
Yes, the billing is done at the beginning.
Yes, my copay is collected at the beginning.
Yes, the nurse checks the BP and vitals and says wait for the doctor.
Yes, the doctor is averaging 9 minutes per visit in each of these offices. That's ~6 people per hour he can visit and 50 people per day, allowing for a light lunch.
Why do we wait so long?
In pharmacy, people can watch as we ready their prescriptions. "Ooh. Ooh. I see mine! There it is. I see it!"

Monday, November 16, 2015

It's Still Illegal

The set up: Pharmacies see the same errors from the same offices all the time. 
Pharmacies call. 
Pharmacies get grief from the Phone Whisperer. 
Offices never change. 
Cycle Repeats...

Local Office Screening Each Request: Thanks for calling the office of Dewey, Screwem, and Howe. Sup?
CP: You can't do this. 
LOSER: Sez who? 
CP: CP. The great and powerful. 
LOSER: Hmm. What makes your word gospel?
CP: Unlike prescribers who think they are Above the Law, or that it does not pertain to them, or they can ignore it, pharmacists' licenses depend upon their compliance with it. 
(To which LOSERs will respond with either or both of the following:)
1. But we've always done it this way. 
2. You're the first/only pharmacist that troubles us over this. 

CP: I see. I see. So, your argument here is that, since you've always broken the law, you are allowed to continue doing so?
LOSER: Yes. I mean, no. I mean, I didn't say that. 
CP: You kinda did. 
LOSER: No I didn't. 
CP: Let me put in context for you. The next time you get pulled over for speeding, try this dialogue with the officer who saunters up to your vehicle: "Well, officer, you see it's like this. I ALWAYS set my cruise at 7MPH above the posted Speed Limit on the Interstate." 
Cynical Highway Patrol: That's not legal. 
LOSER: It's okay. I always do it. 
CHiP: That's not how it works. 
LOSER: Sure it does. I've always done it this way. It works this way at work too. 
CHiP: No. No. No. No. No. Here's a ticket.
LOSER: Okay. I'll just put it in my glove box and ignore it.
CHiP: You can't do that either.
LOSER: Why not? I always do it this way. 

Wednesday, November 11, 2015

Why is it so?

CP: Your copay is $123.45
Have A Little Faith: Why is it that?
CP: That's what the copay is.
HALF: But why?
CP: Why not?
HALF: But I have insurance.
CP: Yes. Yes you do. This is your copay.
HALF: But if I have insurance, why is it so much?
CP: With insurances today, there could be many reasons.
HALF: Such as?
CP: It's expensive? You have bad insurance? You are in the Hole of Donuts?
HALF: But they're just eye drops.
CP: Yes. Eye drops with no generic. Using the qualifier "just" does not just magically make something cheaper or easier to accomplish. That's like telling me I "just" put pills in a bottle.
HALF: Well that doesn't make sense to me.
CP: Lots of things make no sense to me. Particle physics, for example. Yet we have experts on this subject and I have to trust them. You've got to have faith in those who know.
HALF: Well I don't like it.
CP: You don't have to like it. You just have to accept it.
Water's wet and the sky is blue.
The earth is round and global warming's true.
Your insurance pays while you pay too.
Whatever happens, we all get screwed.

Tuesday, November 10, 2015

Dress Code

There must be some sartorial standard patients everywhere just seem to understand. I've never seen an official dress code anywhere, but maybe I'm not on the right mailing list or I don't belong to the right groups. I know I shouldn't be, but I still get surprised at the way people dress when they know they are coming to the pharmacy for flu shots. It's not as if they were in the checkout line, reading the covers of the magazines, and the impulse to buy a pack of gum, batteries, and a flu shot struck them. These are people who planned on coming in for a flu shot.

Women over 60yo--Sweatshirt. Period. Bra optional.
"Sorry. Guess I'm going to have to take it off."

Women 20s to 40s--Under Armour, long sleeve running shirt, skin tight. Vest.
<slides the sleeve up to expose her wrist tattoo> "Is this far enough?"

Men 20s to 50s--Long Sleeve or Business Dress Shirts.
<rolls up sleeve to elbow> "Is this far enough?"

Winter Weather Waiters--Long sleeve T-shirt. Long sleeve top. Sweatshirt. Jacket. Vest. Scarf.
<stretches down neck of tops to expose 1/4" of collarbone> "Will this work?" (Only for a vampire.)

Friday, November 6, 2015

GoPro or Go Home

I believe a new method of rating pharmacy staff is overdue. Where unions make it impossible to get rid of crappy personnel and the chains' frequent managerial turnovers make consistent appraisals unlikely, it's time to take matters into our own hands.

You've likely heard my rants about the need for retesting. I'm in favour of anyone over 65 years old having to retake their driver's test. Look, it makes sense. We could get uber to sponsor it so they could have a legion of retired drivers out there looking for people to drive around. Makes sense.

Back to pharmacy land. I believe we need to retest our techs. My design for this is simple. I will pull one hundred drugs from the shelves and dump them into one giant tote. Each technician, and pharmacist, will be awarded points for accuracy and speed. If you cannot alphabetise, you are a danger. We rely on medications being put away correctly. At the end of the tests, the staff person with the lowest score is voted off the island, or relegated to cashier only.

I hear you. You're absolutely right. Maybe we should make this our first interview task. For companies that like to hold group interviews, this would be a wise way to separate the chaff. "Sorry. Your scores on the Shelf Stuffer Relay were rather dismal. You've been sacked."

Another way to work this in to standard protocol would be to have all staff wear GoPro cameras. This way, when that one technician, and you know who she is, says "wasn't me" when you know damn well it was, you can go to the video that shows her own hand placing the Mirtazapine 7.5mg behind the Meloxicam 7.5 mg bottle because they both have green labels, and fire her.

(This would not be phunny if not for the phollowing: On many days, I will help put away the order. Just for phun, on slower days, I will leave a few items in the totes that I know certain techs will carelessly shelve. For whatever reason, these seasoned vets will prove me right and put each one in the wrong spot. Maybe it's because they look like another product. Maybe they like to put Rectal Rockets in Gen Pop as opposed to the correct location of Rectal/Vag. Either way it just proves that the reckless disregard for such a seemingly mundane task reflects on their approach to the rest of their jobs.)

Tuesday, October 27, 2015

Flu Shot Phun

1. Wear a Kevlar cutting glove on your non-shooting hand. Tell the patient it's to protect your hand because the last time someone came in with arms this small, you had a through-and-through and stabbed yourself. (Yes, I know you can stab through these. They won't know that.)

2. Tell your students, especially those who've not yet experienced hitting bone, that when they do, they need to request a curved needle so they can go around this weird obstruction they found. 

3. When you hit bone, pull out a little, redirect your aim, hit it again, then tell the patient: "There's something in here. I can't get the needle around it. What's wrong with your arm?"

4. Attach a mini laser pointer to your syringe. When the patient asks what it is, tell them it's your laser sight.

5. Attach dart flights to your syringes. Grab a red Sharpie and draw circles on the patient's arm. Have the patient stand against the wall. 

Monday, October 26, 2015


My brain works in mysterious ways. It works faster than the rest of me. It works on the next task before I've managed to get the prior one completed. It sees things differently. It tries to organise and find patterns. This is why I excel at Boggle, Scrabble, and Words With Friends and why people hate playing me. This is also how I came up with today's challenge.

We all know drug companies spend lots of money on research for marketable names and there is a science to it. This is why so many medications have Zs and Xs. Great words for the Scrabble board. Not so great to make other words.

Come up with your own Drug Name Anagrams.
Here are 6 to get you started:

Klonopin=Pink Loon
Xarelto=Tax Lore

Now if I could just get Zynga to create a Pharmacy WWF games...

Thursday, October 22, 2015

More Pharmacy Phun With Words

As I've oft written, I rarely miss an opportunity to have some phun with my staff, phamily, or patients. This is especially true with regards to questions and grammar. A previous lesson involved the questions of time.
Do you know what time it is? is a Yes/No question. Note, I did not ask for the time. I may have simply been nosy inquiring if you knew. I may also have espied you checking your watch and wanted to test your recall. Either way, the correct answer is either Yes or No.

For today's example, I draw upon the conversation I had earlier this week.
CP: Top O' the Morning to You!
Telephone Inquirer Making Exaggerated Requests: And Good Day to you.
CP: How may I help you on this brilliant day?
TIMER: I was hoping to get a phlu shot today.
CP: Most definitely. No better way to spend an autumn day than getting shot.
TIMER: That's what I was thinking.
CP: When would you like to visit our establishment?
TIMER: Well, that's the reason I am calling. I'd hate to be a bother during your busy day.
CP: No worries. We are always busy but we are also quite accommodating.
TIMER: "When are you the least busy?" (The real question)
CP: "When we are closed." (The real answer)
TIMER: Phunny.
CP: I thought so. Did you want to know times when we are less busy?
TIMER: I suppose that would make more sense. Rather difficult to get prescriptions and shots while you are closed, eh?
CP: Indeed.